학술논문
Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia.
Document Type
Article
Author
van Baarle, F. L. F.; van de Weerdt, E. K.; van der Velden, W. J. F. M.; Ruiterkamp, R. A.; Tuinman, P. R.; Ypma, P. F.; van den Bergh, W. M.; Demandt, A. M. P.; Kerver, E. D.; Jansen, A. J. G.; Westerweel, P. E.; Arbous, S. M.; Determann, R. M.; van Mook, W. N. K. A.; Koeman, M.; Mäkelburg, A. B. U.; van Lienden, K. P.; Binnekade, J. M.; Biemond, B. J.; Vlaar, A. P. J.
Source
Subject
*BLOOD platelet transfusion
*CENTRAL venous catheterization
*THROMBOCYTOPENIA
*INTENSIVE care units
*CATHETERIZATION
*PLATELET count
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Language
ISSN
0028-4793
Abstract
BACKGROUND Transfusion guidelines regarding platelet-count thresholds before the placement of a central venous catheter (CVC) offer conflicting recommendations because of a lack of good-quality evidence. The routine use of ultrasound guidance has decreased CVC-related bleeding complications. METHODS In a multicenter, randomized, controlled, noninferiority trial, we randomly assigned patients with severe thrombocytopenia (platelet count, 10,000 to 50,000 per cubic millimeter) who were being treated on the hematology ward or in the intensive care unit to receive either one unit of prophylactic platelet transfusion or no platelet transfusion before ultrasound-guided CVC placement. The primary outcome was catheter-related bleeding of grade 2 to 4; a key secondary outcome was grade 3 or 4 bleeding. The noninferiority margin was an upper boundary of the 90% confidence interval of 3.5 for the relative risk. RESULTS We included 373 episodes of CVC placement involving 338 patients in the perprotocol primary analysis. Catheter-related bleeding of grade 2 to 4 occurred in 9 of 188 patients (4.8%) in the transfusion group and in 22 of 185 patients (11.9%) in the no-transfusion group (relative risk, 2.45; 90% confidence interval [CI], 1.27 to 4.70). Catheter-related bleeding of grade 3 or 4 occurred in 4 of 188 patients (2.1%) in the transfusion group and in 9 of 185 patients (4.9%) in the no-transfusion group (relative risk, 2.43; 95% CI, 0.75 to 7.93). A total of 15 adverse events were observed; of these events, 13 (all grade 3 catheter-related bleeding [4 in the transfusion group and 9 in the no-transfusion group]) were categorized as serious. The net savings of withholding prophylactic platelet transfusion before CVC placement was $410 per catheter placement. CONCLUSIONS The withholding of prophylactic platelet transfusion before CVC placement in patients with a platelet count of 10,000 to 50,000 per cubic millimeter did not meet the predefined margin for noninferiority and resulted in more CVC-related bleeding events than prophylactic platelet transfusion. [ABSTRACT FROM AUTHOR]